Clinical Pearls in the Management of Marginal Zone Lymphoma


Closing out their discussion on B-cell malignancies, expert panelists share clinical pearls on the management of marginal zone lymphoma.

Bijal D. Shah, MD, MS:
As we conclude this session on marginal zone lymphoma, I want to give each panelist a chance to leave with some parting wisdom. I’ll start with you this time, Brian.

Brian T. Hill, MD, PhD: As we’ve discussed, it’s probably not as essential to get early referral for marginal zone lymphoma, but it’s important to recognize when things aren’t going well. If there’s refractory disease, reach out to a referral specialist to get opportunities for clinical trials or insights into what newer agents may be a good option for these patients. If you’re at a smaller center where the surgical team may not be as adept, referring to a larger center for splenectomy is something that can be very effective in a truly refractory patient.

Bijal D. Shah, MD, MS: Michael?

Michael Wang, MD: Lymphoma therapies have so many agents, combinations, classes with CAR [chimeric antigen receptor] T-cell therapy, bispecific antibodies, PI3 kinase inhibitors, immunomodulating agents, etc. So many diseases, so many options. The therapies have become very sophisticated for all lymphomas. I encourage all patients to involve academic centers, and try to get a second opinion early, so your doctors in the academic center can collaborate with your home oncologist. This is very important.

Bijal D. Shah, MD, MS: Caron?

Caron A. Jacobson, MD, MPH: Rather than give advice to the community, I would sum up by saying that this has been an orphan disease and folded into management options for follicular lymphoma. But it’s a disease where we don’t understand the biology nearly as well as we do the more common lymphomas, nor do we have clinical trials that are dedicated to these patients. That’s a void that the lymphoma field needs to fill. We need to understand the biology more, so we can make rational decisions using these agents. We need to have more clinical trials where we enrich these patients.

Bijal D. Shah, MD, MS: Ian?

Ian W. Flinn, MD, PhD: There are many phases of marginal zone lymphoma from the nodal and the extranodal. We didn’t talk about ocular marginal zone lymphomas, but for very localized disease, I wouldn’t count out radiation therapy; it’s an important tool. There’s not 1 way to do any of this. There are many approaches.

Bijal D. Shah, MD, MS: Thank you once again to our panelists and to our audience for joining us. We hope you found this OncLive® Peer Exchange® discussion to be useful and valuable to the treatment of your patients these B-cell lymphomas.

Transcript edited for clarity.

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